Provider Demographics
NPI:1659842482
Name:BLACKBURN, KAREN DOROTHY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DOROTHY
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 NEW HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5606
Mailing Address - Country:US
Mailing Address - Phone:717-606-1865
Mailing Address - Fax:717-606-1995
Practice Address - Street 1:1020 NEW HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5606
Practice Address - Country:US
Practice Address - Phone:717-606-1865
Practice Address - Fax:717-606-1995
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000471L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist